The value of moderate and vigorous physical activity (PA) is well-known and substantiated by a large body of research.1 In addition, research on the value of light activity and the negative effect of sedentary behavior is starting to accumulate.2,3 However, little is known about PA in relation to time spent sedentary and the frequency and length of interruptions in sedentary behavior in overweight and obese patients of safety-net primary care practices such as federally qualified health centers (FQHCs). This study investigated the PA profiles of overweight and obese women, focusing on light activity and breaks in sedentary behavior.

METHODS

We recruited women aged 35 to 65 years from FQHCs for the Healthy Home/Healthy Families Study, a randomized controlled trial for prevention of weight gain. Baseline PA was assessed using accelerometers that participants were asked to wear for 7 consecutive days. Activity levels were scored using the cut points of the National Health and Nutrition Examination Survey.4 The light activity category was further split into quartiles. We calculated descriptive statistics and conducted multivariate regression analysis. The Emory institutional review board approved this study, and all participants provided informed consent.

RESULTS

Participants (N = 303) with valid data (≥4 days with ≥10 hours spent wearing the accelerometer) had a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 38.3 (8.4 [range, 25.0-80.8]); were mostly African American (83.5%); and reported an annual household income of $25 000 or less (62.4%). They wore the accelerometers for a mean of 13.6 h/d (Table 1). Most of the time was spent sedentary (mean [SD], 10.8 [1.8] hours) or in light activity (mean [SD], 2.8 [1.1] hours). Most of the time spent in light activity (95.9%) was spent in the lowest quartile. The women spent a mean duration of less than 1 min/d in moderate PA and none in vigorous PA. No participant met the 2008 US Department of Health and Human Services PA guideline. The participants’ body mass indexes were positively associated with time spent being sedentary, and employed participants were significantly less sedentary than those who were not employed.

Participants interrupted their sedentary behavior for at least 1 minute 79 times per day (Table 2). Of those breaks, almost two-thirds lasted at least 2 minutes. However, data showed a mean of only 9.5 interruptions per day of at least 10 minutes and only 3.0 interruptions of at least 20 minutes. Those participants who were employed interrupted their sedentary behavior for more than 1 minute more often than those who were not. More overweight participants had fewer 10- and 20-minute interruptions of sedentary behavior than those with a lower body mass index.

DISCUSSION

To our knowledge, this study is one of the first to obtain accelerometer data on PA levels among a relatively large sample of low-income, predominantly African American overweight and obese female patients of FQHCs in rural Georgia and to show extremely sedentary behavior in this population. Participants spent a negligible amount of time in moderate activity, and the time spent in nonsedentary activity was mostly of very low intensity and short duration.

What do these findings mean for safety-net health care providers as they implement the Patient-Centered Medical Home Standards?4 Clinicians need to assess their patients’ levels of PA and subsequent inactivity to tailor counseling. Their focus might need to shift to increasing light PA and the number and lengths of breaks in sedentary behavior. However, this change is unlikely to be addressed effectively in typical primary care office visits or by physicians alone. More intensive strategies need to be developed to address the motivational changes required.5

In conclusion, results from this study might indicate a new silent epidemic of a supersedentary lifestyle that might contribute significantly to the health disparities seen in poor and minority populations served by FQHCs. These findings highlight the challenges faced by safety-net providers in promoting healthy lifestyles in their patients.

Critical revision of the manuscript for important intellectual content: Haardörfer, Hotz, Kegler.

Statistical analysis: Haardörfer.

Obtained funding: Kegler.

Administrative, technical, and material support: Hotz.

Study supervision: Kegler.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by Cooperative Agreement 5U48DP001909 from the Centers for Disease Control and Prevention.

Role of the Sponsor: The funding source had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional Contributions: The members of the Emory Prevention Research Center Community Advisory Board provided guidance in the design and implementation of this research. The Cancer Coalition of South Georgia provided local study coordination. Albany Area Primary Health Care, the South Central Primary Care Center, and the Primary Care Center of Southwest Georgia referred participants. Julie A. Gazmararian, PhD, Rollins School of Public Health, contributed to the study design, interpretation of the data, and drafting and review of the manuscript and was compensated for her work on the study from the grant listed above. We thank our study staff and study participants for their valuable contributions to this research.

Correspondence

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with
the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.

Indicate what change(s) you will implement in your practice, if any, based on this CME course.

Your quiz results:

The filled radio buttons indicate your responses. The preferred responses are highlighted

For CME Course:
A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes

Indicate what changes(s) you will implement in your practice, if any, based on this
CME course.

Instructions

Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.

Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.

* = Required Field

Comment Author(s)* (if multiple authors, separate
names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.

This feature is provided as a courtesy. By using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to the AMA's Terms of Use. The information provided in order to email this article will not be shared, sold, traded, exchanged, or rented. Please refer to The JAMA Network's Privacy Policy for additional information.

Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.

What is this ?

Article rental gives users the ability to access the full text of an article and its supplementary content for 24 hours.
Access to the PDF is only available via article purchase.